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MONIT(WING SYSTEM CERTIFWATION MAKE / MODEL OF MONITORING SYSTEM: Veeder-Root TLS-350 CERTIFICATION /TEST DATE: March 5, 2010 A1. FACILITY A2. OWNER Name 7-Eleven Market#2368/Store#32190 Name 7-Eleven, Inc Address 4943 South State Route 99,Stockton,CA 95206 Address P.O. Box 711, Dallas,TX 75221 Phone# 209-939-0679 Phone# 805-523-2949 Contact Jay Stemley Contact Jay Stemley A3. C U P A A4. TESTING CONTRACTOR Name San Joaquin County Environmental Health Name Walton Engineering, Inc. Address 600 E. Main Street,Stockton,CA 95202 Address P.O.Box 1025,W.Sacramento,CA 95691 Notified March 1, 2010 Lic# 617238 A, B, Haz Inspector Thuy Tran Contact Richard Walton Phone# 209-468-3439 Phone# 916-825-3203 B. INVENTORY OF EQUIPMENT TESTED/CERTIFIED (Check the appropriate boxes to indicate equipment inspected/serviced) B1: TANKS Tank#4 (Product): Gasoline.87 Tank#5 (Product): Gasoline -89 ❑ In-Tank Gauging Probe Model: ❑ In-Tank Gauging Probe Model: ■ Annular Space or Vault Sensor Model: 0794380-303 ■ Annular Space or Vault Sensor Model: 0794380403 ■ Piping Sump I Trench Sensoria) Model: 0794380.208 ■ Piping Sump I Trench Sensor(s) Model: 0794380-208 ■ Fill Sump Sensor(s) Model: 0794380.208 ■ Fill Sump Sensor(s) Model: 0794380.208 ❑ Mechanical Line Leak Detector Motlel: ❑ Mechanical Line Leak Detector Model: ■ Electronic Line Leak Detector Model: 0848480-001 ■ Electronic Line Leak Detector Model: 0848480-001 ❑ Tank Overfill i High-Level Sensor Model: ❑ Tank Overfill I High-Level Sensor Model: ❑ Other (specify equipment in Section E) Model: ❑ Other (specify equipment in Section E) Model: Tank#6 (Product): Gasoline-91U0794380.303 nk#4 (Product): ❑ In-Tank Gauging Probe Model: In-Tank Gauging Probe Model: ■ Annular Space or Vault Sensor Model: Annular Space or Vault Sensor Model: ■ Piping Sump I Trench Sensor(s) Madel: Piping Sump/Trench Sensor(s) Model:■ Fill Sump Sensor(s) Model: Fill Sump Sensor(s) Model: ❑ Mechanical Line Leak Detector Motlel: Mechanical Line Leak Detector Motlel:■ Electronic Line Leak Detector Model: Electronic Line Leak Detector Model:❑ Tank Overfill I High-Level Sensor Motlel: Tank Overfill l High-Level Sensor Motlel:❑ Other (specify equipment in Section E) Model: 1111 Other (specify equipment in Section E) Model: 132: DISPENSERS/UDC's 7Valves : 1-2 Dispenser#: 3-4 r Containment Sensor(s) Model: 0794380.208 ■ Dispenser Containment Sensor(s) Model: 0794380-208 ves ■ Shear Valves r Containment Floags)antl Cham(s) ❑ Dispenser Containment Floats)and Chain(s) : 5-6 Dispenser#: 7-8r Containment Sensoria) Model: 0794380-208 ■ Dispenser Containment Sensor(s) Model: 0794380.208 ■ Shear Valves ■ Shear Valves ❑ Dispenser Containment Floats)and Cham(s) ❑ Dispenser Containment Floats)and Chan(s) Dispenser#: 9-10 Dispenserit: 11-12 ■ Dispenser Containment Sensor(s) Model: 0794380408 ■ Dispenser Containment Sensor(s) Model: 0794380.208 ■ Shear Valves ■ Shear Valves ❑ Dispenser Containment Float(s)and Chain(s) ❑ Dispenser Containment Float(s)and Chain(s) C. CERTIFICATION I certify that the equipment identified in this document was inspected/serviced in accordance with the manufacturers''guidelines. Attached to this Certification is information(e.g.manufacturers'checklists)necessary to verify that this information is correct and a Plot Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports,I have also attached a copy of the report; (check all that apply): ■ System set-up ■ Alarm History Report WALTON—_-—---"-- Signature: ��- E NGMEERING.INC. _...... Technician I Cert M Anthony Rosario B3703418010967-UT Date: March S, 2010 2006 W.1to.Engmeenng,I.c.